2006-06-20_REPORT - M1997065

• Permit No: M1997065
• IBM Index Class Name: Report
• Doc Date: 6/20/2006
• Doc Name: Annual Fee/Report/Map
• From: Western Nutrients Inc
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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/ ANNITAT. FF,F, and RF,PORT RF.niiF.ST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNNERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
'//Western Nutriensts, Inc.
/ M-1997-064
Agri-Cal #1
July 9, 2006
rl'/~'
RECEO'~ED
t/JUN Z 0 2006
Division of Minerals and Geology
$225.00 (Due on or before your anniversary date)
Fremont
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an
operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected
_ _ land, reclamation accomplished o date_and during_the_preceding year,_new_distiuliarices_that.are anticipated 10 _ _
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach yonr revised written anmral rennrt and anmral rennrf mar to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written
report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Jeny Screws
Permittee Name: Western Nutrients, Inc.
Address: 6062 Umber St.
Arvada, CO 80403-7464
Phone Number:- _.(303).422-9509.. _ - _ _ _ _
Fax Number: [phone]
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
/°S. ~ ~~
Signature of Corporate Officer, Owner, or Designee
6 ~3~0 6
Dat~
M:NERMITMA5TEADOCUMEMS/M-AF-02.DOC